Active NPI
Kristen Modesitt, LCSW
- Clinical Social Worker
- Tampa, FL
National Provider Identifier
1790147585
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW7728
- Practice address
- 12902 Usf Magnolia Dr
Tampa, FL 33612-9416 - Phone
- (813) 745-2469
- NPI assigned
- Mar 22, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW7728 | FL | Primary |
Addresses
Primary practice location
12902 Usf Magnolia Dr
Tampa, FL 33612-9416
Mailing address
12902 Usf Magnolia Dr
Tampa, FL 33612-9416
Phone (813) 745-2469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW7728 | FL | MD | Clinical Social Worker |
Interoperability endpoints
- kristen.modesitt@532070890209284.direct.elationemr.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458604800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458604800000",
"number": "1790147585",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12902 USF MAGNOLIA DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336129416",
"telephone_number": "813-745-2469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12902 USF MAGNOLIA DR",
"city": "TAMPA",
"state": "FL",
"postal_code": "336129416",
"telephone_number": "813-745-2469"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MODESITT",
"first_name": "KRISTEN",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-03-22",
"last_updated": "2016-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW7728",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tampa, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.